Will the Hospital Pricing Transparency Law Really Help Consumers

     Beginning in January, hospitals were required to provide an online list of pricing for procedures, services and anything dispensed for your care be it a bandage, pill or blood test. Critics have touted that all this information will be of little use to the consumer because the prices are inflated and negotiated down by insurance companies.    Furthermore, navigating through the convoluted list of procedures and medical codes can be a daunting task.
     I decided to see for myself how hard it would be to find pricing for a surgical procedure.  I chose an appendectomy, and after an hour of searching on three hospital websites, I was only able to find pricing on one site.  I had to go online to look up information on the medical terminology and coding for the procedure to attempt to find it in the long, confusing lists.  On two of the sites, I couldn’t find it at all.
      While this new law attempts to require hospitals to provide information for consumers to comparison shop, it is of little use until something is done to make it more user-friendly. Hospital pricing has long been guarded as proprietary information, and until the hospital administrators make a commitment to true transparency, patients will continue to be on their own navigating the convoluted billing practices in place.

Covered CA Open Enrollment Period For 2019 Coverage

     Open enrollment  for Covered California begins October 15 and ends January 15, 2019.  This is the time to change your current plan or sign up for new coverage. 
     Despite rising premiums, the uninsured rate remained at 8.8 percent last year with nearly 28.5million Americans without insurance. Uninsured rates are expected to rise next year when the individual mandate is lifted.
     In 2018, under new guidance from the Trump administration, the Centers for Medicare and Medicaid will allow individuals to claim hardship exemptions without providing supporting documentation. A hardship might be classified as a bankruptcy, fire, flood or homelessness or other circumstance that made it impossible to get insurance.  Without an exemption, an individual would pay either $695 or 2.5  percent of income, whichever is higher.
     “Although the tax cuts signed by the President earlier this year eliminate the mandate penalty starting in 2019, Americans are still under threat of the penalty for this tax year of 2018,” CMS Administrator Seema Verma said in a statement clarifying the rules for this year.

8.7% Covered California 2019 Rate Increase

     Covered California has announced a projected 8.7% rate increase on 2019 health plans despite recent court rulings in New Mexico and Massachusetts. The rulings suspended $10 billion in “risk adjustment” payments meant to
stabilize the insurance market.
     The program transfers money from insurers with healthier enrollees to those with enrollees who are more at risk in order to avoid “cherry-picking” by companies who take only the healthiest people.
     Despite Congress’s failed attempt last year to repeal and replace the ACA, the Trump administration has been able to weaken the health law by halting subsidies covering some out-of-pocket costs and eliminating the mandate to have insurance.
     Critics said that the suspension of payments will drive up costs and further undermine the ACA. Dave Jones, California Insurance Commissioner, maintained that the “Trump administration has just taken another step to sabotage the nation’s health insurance market.”

How The Federal Tax Law Affects Healthcare Coverage in 2018

     It will be ‘business as usual’ for healthcare with the main components of the Federal tax law going into effect in January 2019. What is still in play for 2018? Subsidy assistance for those who qualify, the penalty for not having insurance, and guarantee issue for those with preexisting conditions. In California, the Open Enrollment Period to get a health insurance plan is extended to January 31, 2018.
     How the lifting of the federal mandate will affect healthcare markets is unclear. The GOP, however, is elated at the removal of  the cornerstone of the Affordable Care Act.
     “Obamacare’s coercive individual mandate represents perhaps the worst example of the federal government violating individual freedom and liberty,” Rep. Mark Walker (R-N.C.), chairman of the conservative Republican Study Committee.
     The American Academy of Actuaries, in a warning to congressional leaders, stated that if the mandate is eliminated, “premiums would increase as a result, reducing affordability and eroding preexisting condition protections.”
     In California, it is estimated that 1.7 million fewer individuals will be without health insurance over the next decade with the repeal of the mandate.  Experts predict many young, healthy people will drop coverage if it is not required.

Californians Fear Losing Health Coverage

A poll by the Institute of Governmental Studies at the University of California-Berkeley shows more than half of Californians fear they or a family member will lose health coverage if the Affordable Care Act is repealed.

For those with household incomes of less than $20,000 per year and people enrolled in Medi-Cal, the concern is even greater.  Medi-Cal covers 13.5 million Californians, and nearly 4 million of those enrolled were covered as a result of  Medi-Cal’s expansion under Obamacare.

“We all have friends or relatives who are or have been on this program,” said Jennifer Kent, director of the State Department of Health Care Services, which administers Medi-Cal. “The state has literally bent over backwards to make the ACA work.  This poll is basically now showing that people are appreciating what has been built and are worried that it’s going to be taken back down again.”

The GOP bill passed by the House in early May would eliminate the major tenets of Obamacare and cap federal funding of Medicaid. The Congressional Budget Office estimated that the bill would  cause nearly 23 million more people to lose health coverage by 2026 and federal spending on Medicaid would be cut by $834 billion over 10 years.

U.S. Senate leaders are drafting their own version of a health bill with a vote expected before July 4.


Key Aspects of American Health Care Act Proposed

The changes to the ACA addressed in the American Health Care Act will not be final until passed by Congress but already criticism of some of the key aspects are being voiced by some Republican Senators. All are from states that expanded Medicaid under the ACA and indicated they would not support a plan that would leave millions of Americans uninsured. In a letter to Senate Majority Leader Mitch McConnell, Senators Rob Portman of Ohio, Shelley Moore Capito of West Virginia,  Cory Gardner of Colorado and Lisa Murkowski of Alaska stated “We will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states.”

Medicaid expansion implemented in the ACA would end in 2020 under the new Act. People already enrolled would continue to get coverage, but new enrollees would be prohibited, and those who leave coverage could not return to expanded coverage.

Other key changes include:

  • Suspension of the mandate requiring individuals to sign up for health insurance – However, there would be a 30% surcharge if you let your coverage lapse and want to get coverage at a later date.
  • Elimination of the premium subsidies for those with low to middle incomes – These would be replaced with tax credits for individuals who have annual incomes below $75,000 or married couples with annual incomes below $150,000.
  • Pre-existing conditions will continue to be covered and charged at the same rate as those without pre-existing conditions.  The ban on lifetime and annual limits would remain in place.
  • Some large employers would not have to offer health coverage to employees – However, the 40% Cadillac Tax would remain in effect on plans that cost more that $10,200 for individuals and $27,500 for families.
  • Under the new plan insurers could charge older people five times what they charge younger ones.  Under the ACA, it was capped at three times the rate.
  • Children up to age 26 can remain on their parents’ plans under the American Health Care Act – Same as the ACA







‘Universal Access’ Goal of GOP

     The GOP’s replacement for Obamacare will likely eliminate the mandate that everyone must get health insurance or be fined. With 20 million people now covered with ACA plans through federal exchanges, the number of uninsured is at record lows. Although Republicans are certain to repeal the law, they are assuring that there will be a transition period, and no one will lose coverage on January 20, 2017 when President-elect Trump is inaugurated.
     “There’s a lot of scare tactics out there on this,” said Texas Representative Kevin Brady, chairman of the Ways and Means Committee.  “We can reassure the American public that the plan they are in right now, the Obamacare plans, will not end on January 20.”
A House aide confirmed that repealing provisions of the law
is a priority, but added there would be a transition period of anywhere from 2 to 4 years to allow time to make replacement coverage available.
     “Our goal here is to make sure that everybody can buy coverage or find coverage if they choose to,” the aide said at a Republican-organized briefing.
     The future of the cost-sharing subsidies that reduce out-of-pocket costs of low-income people has yet to be decided, according to the aide.  In May, a federal district judge ruled the Obama Administration paid out billions to insurers even though Congress had not appropriated money for the payments. That money is key to the success of the the federal exchanges.
     Despite the uncertainty, people continue to sign up for the plans in record numbers. So far, nearly 670,000 have chosen health insurance plans on federal exchanges. Open enrollment ends on January 30, 2017.